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    <div style="text-align:center;"><h2>老年人认知功能量表</h2></div>

    <table id="tab">
        <tr>
            <td>姓名</td>
            <td><input type="text" class="labelText" id="name" /></td>
            <td>性别</td>
            <td><input type="text" class="labelText" id="sex" /></td>
            <td>年龄</td>
            <td><input type="text" class="labelText" id="age" /></td>
        </tr>
        <tr>
            <td>既往病史</td>
            <td colspan="5"><input type="text" class="inputText" id="lnrrzgn_jwbs" /></td>
        </tr>
        <tr>
            <td>文化程度</td>
            <td colspan="5">
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_whcd" />1.研究生</label>
                <label name="2"><input type="checkbox" name="cb_lnrrzgn_whcd" />2.大学本科</label>
                <label name="3"><input type="checkbox" name="cb_lnrrzgn_whcd" />3.大学专科和专科学校</label>
                <label name="4"><input type="checkbox" name="cb_lnrrzgn_whcd" />4.中等专业学校</label>
                <label name="5"><input type="checkbox" name="cb_lnrrzgn_whcd" />5.技工学校</label>
                <label name="6"><input type="checkbox" name="cb_lnrrzgn_whcd" />6.高中</label>
                <label name="7"><input type="checkbox" name="cb_lnrrzgn_whcd" />7.初中</label>
                <label name="8"><input type="checkbox" name="cb_lnrrzgn_whcd" />8.小学</label>
                <label name="9"><input type="checkbox" name="cb_lnrrzgn_whcd" />9.文盲或半文盲</label>
                <label name="10"><input type="checkbox" name="cb_lnrrzgn_whcd" />10.不详</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">项目</td>
            <td colspan="2">记录</td>
            <td colspan="2">评分</td>
        </tr>
        <tr>
            <td rowspan="11">I定向力（10分）</td>
        </tr>
        <tr>
            <td colspan="2">星期几</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_xqj" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_xqj" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_xqj" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">几月</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_jy" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_jy" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_jy" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">几号</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_jh" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_jh" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_jh" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">什么季节</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_smjj" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_smjj" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_smjj" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">哪一年</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_nyn" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_nyn" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_nyn" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">省市</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_ss" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_ss" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_ss" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">区县</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_xq" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_xq" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_xq" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">街道或乡</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_jdhx" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_jdhx" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_jdhx" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">什么地方</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_smdf" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_smdf" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_smdf" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">第几层楼</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_djcl" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_djcl" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_djcl" />1</label>
            </td>
        </tr>

        <tr>
            <td rowspan="4">II记忆力（3分）</td>
        </tr>
        <tr>
            <td colspan="2">皮球</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_jyl_pq" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_jyl_pq" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_jyl_pq" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">国旗</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_jyl_gq" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_jyl_gq" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_jyl_gq" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">树木</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_jyl_sm" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_jyl_sm" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_jyl_sm" />1</label>
            </td>
        </tr>

        <tr>
            <td rowspan="6">III注意力和计算力（5分）</td>
        </tr>
        <tr>
            <td colspan="2">100-7</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_zylhjsnl_0" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_zylhjsnl_0" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_zylhjsnl_0" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">-7</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_zylhjsnl_1" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_zylhjsnl_1" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_zylhjsnl_1" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">-7</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_zylhjsnl_2" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_zylhjsnl_2" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_zylhjsnl_2" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">-7</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_zylhjsnl_3" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_zylhjsnl_3" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_zylhjsnl_3" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">-7</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_zylhjsnl_4" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_zylhjsnl_4" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_zylhjsnl_4" />1</label>
            </td>
        </tr>

        <tr class="PageNext"></tr>

        <tr>
            <td rowspan="4">Ⅳ回忆能力（3分）</td>
        </tr>
        <tr>
            <td colspan="2">皮球</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_hynl_pq" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_hynl_pq" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_hynl_pq" />1</label>
            </td>
        </tr>
        <tr>
            <td colspan="2">国旗</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_hynl_gq" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_hynl_gq" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_hynl_gq" />1</label>
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        </tr>
        <tr>
            <td colspan="2">树木</td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_hynl_sm" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_hynl_sm" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_hynl_sm" />1</label>
            </td>
        </tr>

        <tr>
            <td rowspan="12">Ⅴ语言能力（9分）</td>
        </tr>
        <tr>
            <td rowspan="3">命名能力</td>
        </tr>
        <tr>
            <td><input type="text" class="inputText" id="lnrrzgn_yynl_mmnl_1_wt" /></td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_yynl_mmnl_1" /></td>
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                <label name="0"><input type="checkbox" name="cb_lnrrzgn_yynl_mmnl_1" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_yynl_mmnl_1" />1</label>
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            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_yynl_mmnl_2" /></td>
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                <label name="0"><input type="checkbox" name="cb_lnrrzgn_yynl_mmnl_2" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_yynl_mmnl_2" />1</label>
            </td>
        </tr>
        <tr>
            <td>复述能力</td>
            <td><input type="text" class="inputText" id="lnrrzgn_yynl_fsnl_wt" /></td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_yynl_fsnl" /></td>
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                <label name="0"><input type="checkbox" name="cb_lnrrzgn_yynl_fsnl" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_yynl_fsnl" />1</label>
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        </tr>
        <tr>
            <td rowspan="4">三步命令</td>
        </tr>
        <tr>
            <td><input type="text" class="inputText" id="lnrrzgn_yynl_sbml_1_wt"  /></td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_yynl_sbml_1" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_yynl_sbml_1" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_yynl_sbml_1" />1</label>
            </td>
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        <tr>
            <td><input type="text" class="inputText" id="lnrrzgn_yynl_sbml_2_wt" /></td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_yynl_sbml_2" /></td>
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                <label name="0"><input type="checkbox" name="cb_lnrrzgn_yynl_sbml_2" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_yynl_sbml_2" />1</label>
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                <label name="0"><input type="checkbox" name="cb_lnrrzgn_yynl_sbml_3" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_yynl_sbml_3" />1</label>
            </td>
        </tr>
        <tr>
            <td>阅读能力</td>
            <td><input type="text" class="inputText" id="lnrrzgn_yynl_ydnl_wt" /></td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_yynl_ydnl" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_yynl_ydnl" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_yynl_ydnl" />1</label>
            </td>
        </tr>
        <tr>
            <td>书写能力</td>
            <td><input type="text" class="inputText" id="lnrrzgn_yynl_sxnl_wt"  /></td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_yynl_sxnl" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_yynl_sxnl" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_yynl_sxnl" />1</label>
            </td>
        </tr>
        <tr>
            <td>构造能力</td>
            <td>
                <img src="" />
            </td>
            <td colspan="2"><input type="text" class="inputText" id="lnrrzgn_yynl_gznl" /></td>
            <td>
                <label name="0"><input type="checkbox" name="cb_lnrrzgn_yynl_gznl" />0</label>
                <label name="1"><input type="checkbox" name="cb_lnrrzgn_yynl_gznl" />1</label>
            </td>
        </tr>

        <tr>
            <td>总分</td>
            <td colspan="5"><input type="text" id="lnrrzgn_sum" style="width:80px;float:left;border-bottom: black 1px solid;border-top-style: none;border-right-style: none;border-left-style: none;background-color: transparent;text-align:center;" readonly="readonly" /></td>
        </tr>

        <tr>
            <td>评定时间*</td>
            <td colspan="2"><input type="text" class="labelText" id="pdsj" /></td>
            <td>录入人</td>
            <td colspan="2"><input type="text" class="inputText" id="lrr" /></td>
        </tr>

        <tr>
            <td>评定机构</td>
            <td colspan="2"><input type="text" class="labelText" id="pdjg" /></td>
            <td>录入时间</td>
            <td colspan="2"><input type="text" class="labelText" id="lrsj" /></td>
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